New report details dispersed approach to aging well in Canada

At 91, Olga Libaque lives on the razor’s edge.

This is how Olga’s son, Jaime, describes his life. She wants to remain an independent woman, but as her dementia worsens, Olga forgets to use a cane or wear her fall-alert device, leaving her bruised and alone.

“The more time passes, the more I worry,” said Jaime Libaque, IT project manager in Toronto.

For now, Olga lives alone, dependent on her children when they are not at work. She happily chats in Spanish every Tuesday with her friends at a local community center. Ontario gives her two 45-minute sessions a week of home care (for showers) and she receives several hours of light housekeeping each month from a City of Toronto program for low-income residents, including Jaime was unaware of the existence until Olga’s geriatrician rallied additional support.

Olga is one of the many elderly people who live hand to mouth. By 2031, almost a quarter of all Canadians will have reached the age of 65.

And while baby boomers may rebel against the mid-1960s definition of “old,” the coming population explosion provides a warning to governments: time is running out to prepare Canadians for a healthy end of life. , although the vast majority say they want to avoid institutional care through new options in the community.

Or, as the National Institute on Aging calls it, « aging in the right square. »

In a 95-page report released Thursday, the NIA detailed Canada’s patchwork approach to community support, home care and living options, leaving many facing a struggle similar to Olga’s. in the community, hospitals or large institutional-style retirement homes, often far from families.

“We know that aging in the community is what Canadians want and need, but for many we are falling short of that goal,” said Dr. Samir Sinha, director of geriatrics at Sinai Health and University Health. Network. Sinha is also Olga’s geriatrician.

As the number of Canadians 85 and older is expected to triple to 2.5 million in 2050, many could thrive in the community with support, said the NIA report, titled Aging in the Right Place: Helping older Canadians live where they want. »

Older people increasingly demand new housing options and services as they age.

Some will need nursing homes, Sinha said, especially those who require high levels of care and don’t have family or friends who can help them. But the majority of Canadians could live healthier lives in the community if, according to the report, governments focused on “four pillars that are fundamental to aging in the right place.”

These “pillars” are:

People living with cognitive decline and their caregivers are most at risk, the report says. And that’s a problem because by 2030, nearly one million Canadians will have dementia, a 65% increase from 2020, according to the Alzheimer Society of Canada. By 2050, this number will reach 1.7 million.

And, according to the NIA report, dementia is one of the strongest predictors of nursing home admissions, especially among people age 85 and older.

“Dementia also has major implications for chronic disease management, as it becomes increasingly difficult for a person to independently manage their chronic health conditions,” the report states. He calls for dementia prevention programs, highlighting the risks created by depression, social isolation and lack of physical activity.

In its report, the NIA does not specifically define “long-term care” as nursing homes, but (like the Europeans) as a range of services and supports for older people that include home care in the community. as well as nursing or retirement homes or assisted living. .

Citing data from the Organization for Economic Co-operation and Development, the NIA report says Canada’s « long-term care » spending accounted for 18.5% of its total health spending in 2019.

Canada’s spending was lower than that of Norway (29.5%), the Netherlands (28%) and Sweden (26.3%). Of 36 countries rated, Canada ranked 12th in long-term care spending, followed by Iceland, the United States and the Czech Republic. Do we need to elaborate a bit more that spending more is a good thing in this analysis? i.e. as opposed to wasting

The NIA report also noted that Canada’s spending was heavily weighted in institutional care, such as nursing homes, which received 64% of spending in 2019, compared to an OECD average of 52%. Canada spent 18% on home and community care. The OECD average was 36%, according to the report.

Although all levels of government fund some programs and services for seniors, this is not enough to meet the needs of the new population, let alone those of seniors like Olga who are trying to stay home with just a few hours. help.

“You can imagine the dread and helplessness that a lot of people feel,” Sinha said, “as opposed to this idea of ​​aging with confidence and feeling confident that there will be the right mix of support services for you. meet you and your family where you are, allowing you to honor the wishes you have.

Reality, he said, leaves older people feeling trapped.

“They can see where this is leading. They may see themselves being prematurely institutionalized.

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